Monday, April 30, 2007

Long time readers of my blog will know that as far as nutrition policy goes the Canadian government's not exactly a stellar performer (though to be fair, I'm sure there are many folks in Health Canada and other spheres of government that care deeply about nutrition).

Thursday, April 26, 2007

That's the very unfortunate name of a very unfortunate new show being planned in Australia.

According to the report, the premise is pretty straightforward: 10 overweight children spend one month living with Australian aboriginals and during that month, they are only allowed to eat foods that they procure and hunt themselves using traditional aboriginal techniques.

Apparently this is not the first such show as it's mirroring a British show entitled, "Fat Men Can't Hunt" which involved sending overweight men to Namibia with similar rules.

This is wrong on so many levels. From the potential of worsening body image issues in the children, to the show not teaching them anything about how to eat and "hunt" nutritiously in our urban jungles, to the exploitation of these children's obviously desperate vulnerability and lastly to the fact that the show is so outrageous that despite all of my concerns, the voyeur in me wants to watch it.

On a number of occasions I've been approached by television news or morning shows to have them follow a patient through my program. I've turned them down every time. Weight loss is a personal decision and a personal journey and involves changing a lifestyle. Lifestyle change is difficult and I would never want to add the additional burden and pressure of television exposure to any of my patients.

I do worry how this show is going to affect those children.

If this really were a reality television show I'd have them take the parents and not the kids.

[Hat tip to a blog I happened across yesterday - Rudd Sound Bites; an informative and biting blog written out of Yale's Rudd Center for Food Policy and Obesity]

Wednesday, April 25, 2007

It's rare that in one post I get to cover research and Big Food quobesity, but clearly today's going to be a special day.

First the research.

A study published in this week's Journal of Nutrition compared the after effects of eating either a) 830 Calories of high fat McDonald's breakfast items (2 hash browns, 1 Sausage McMuffin and 1 Egg McMuffin) vs b) 820 Calories of low fat sugary breakfast items (Kellogg's Frosted Flakes, skim milk, fat free yogurt, a Kellogg's fruit loop bar and Sunny Delight orange juice). The meals were controlled for salt by having the low fat test group also consume 1,000mg of salt to make things even. Researchers then watched subjects performing "stress tasks" which included arithmetic, public speaking, pain tolerance, and cold tolerance and measured their blood pressure responses throughout.

What was found was that folks with the high fat preload had significantly higher blood pressure responses to all of these stressors along with higher total peripheral resistance. This led the authors to conclude,

"a single high-fat meal may lead to heightened cardiovascular reactivity in healthy, normotensive individuals"

or more simply, high-fat meals may temporarily give high blood pressure to folks whose blood pressures are usually normal.

Frankly the study didn't excite me that much which is why I didn't report on it yesterday. It only had 30 subjects, didn't report how long this effect lasted and really, how stressful is the time immediately following a meal for most folks?

Now the Quobesity.

While the study might not have excited me too much, I absolutely loved McDonald's press release this morning on the matter. Here it is in its entirety though I've highlighted the bits I like best:

"While we appreciate ongoing health and wellness research, we're disappointed that this preliminary study does not tell the whole nutrition story at McDonald's and makes broad conclusions based on only one combination of menu items.

At McDonald's Canada, we're proud of our food and have been a leader in serving quality breakfast options for more than 30 years. We have always believed in the sound nutritional principles of balance, variety and moderation and that McDonald's can be part of any balanced, active lifestyle.

The breakfast combination used in the report provides only a small example of a much larger menu from which to choose. For example, many of our customers do enjoy a balanced breakfast consisting of an Egg McMuffin, Fruit 'n Yogurt Parfait and small orange juice, all of which combine elements from the four food groups and fall within recommended daily values as outlined in Canada's Food Guide.

We're always listening to our customers and have been a leader in providing them with complete nutrition information, both in our restaurants and online at www.mcdonalds.ca, to help them make responsible choices that are right for them and their lifestyles."

McDonald's you guys are the best. Thank you for looking out for me and my family. I know our health means much more to you than your bottom line and your press release this morning certainly proves that. Please ignore all of those naysayers who get mad at small things like exploitative advertising targeting children, portions that are larger than anyone could argue are healthy and the overt hucking of larger sized foods as being of great value. You guys are the Kings and Queens of nutritional advocacy - don't let anyone ever tell you different.

(FYI: If you think the meal consumed at McDonald's was excessive and not representative of McDonald's breakfasts you might be right - some have more Calories and more fat. Eat the McDonald's Deluxe Breakfast pictured at the top of this post and according to the McDonald's website you'll be having 1,380 Calories with 67 total grams of fat including 13 grams of trans fat. YUMMY! Think it's a coincidence that the item ID on the hyperlinked URL is 6666?)

Leptin is a fairly well understood hunger/satiety hormone. It was discovered in the 90s out of studies of an obese mouse model and it's produced by our bodies' fat cells. Leptin's job is to help let the brain know we're full and binding of leptin to the satiety centre of our brains (the hypothalamus) is one of the body's satiety signals.

Folks with two defective leptin receptors are morbidly obese and providing them with leptin injections confers massive weight loss.

Before you get too excited about the potential for leptin to benefit folks with weight management issues you should know that to date there have only been a few dozen folks worldwide who have been shown to have two defective leptin receptors and that obesity researchers got far too excited about leptin's role in treatment and to date virtually every study ever done on leptin replacement as a weight management tool has been a major disappointment unless you're one of those few dozen individuals with the exceedingly rare combination of two defective leptin genes.

In folks with significant amounts of weight, one of the proposed mechanisms or contributors is in fact leptin resistance whereas their bodies actually produce more leptin (remember it's produced in the fat cells themselves), it's just that their bodies don't seem to respond to it.

Back to the baby formula. Professor Cawthorne is basing his idea off of a couple of rat studies: In the first study suckling rats were given 4 times the amount of leptin normally ingested from their mothers and later in life were found to be lighter and eat fewer Calories. The second study, administered leptin to pregnant rats and found that their offspring were leaner and lighter. Putting these studies together Professor Cawthorne is designing an infant formula that has leptin added to it.

What's fascinating to me is the fact that to an extent, these studies have already been conducted in humans and their results have proven to be woefully disappointing.

You see, we know that folks with significant amounts of weight produce a great deal more leptin than lean folks, and that therefore obese pregnant women's babies are exposed to a great deal more in-utero leptin and more breast milk leptin. Yet we know that having a parent with a significant amount of weight vastly increases the risk of that child being an obese adult. If you were like Dr. Cawthorne and wanted to make an overly simplistic leap, you might even want to paradoxically blame the leptin.

I don't think that would be wise either.

For me obesity is not a single cause issue. At the end of the day there are an incredible myriad of factors that influence how much we eat and how much we burn. When I read stuff like Mike Cawthorne's formula plans the cynic in me wonders how much the fact that there's a 50-100 billion dollar industry out there where folks buy hope in the form of miracle pills, tablets and cures, influences the plans of such formulations.

Scary stuff jumping from bench to bedside in one fell swoop. Who knows what kind of other longterm implications might occur with such a plan, including the possibility of a worsening of future weight, or unforeseen and unrelated after effects.

Monday, April 23, 2007

So I opened up the parenting magazine that we've been getting for free since the birth of our latest daughter and I came across this ad from Big Beef telling me that the Heart and Stroke Foundation of Canada wants me to eat red meat.

So I asked myself, why? Why does the Heart and Stroke Foundation think so much of red meat that they've given it a "Health Check", their symbol meant to indicate a good for your health type option?

I'm not aware of any study that has demonstrated any significant health benefits with red meat consumption.

On the contrary, I'm aware of many studies that have demonstrated the dangers of red meat consumption - from breast cancer (in post-menopausal women, intake of just 60 grams per day increased their risk of breast cancer by 57%), to colon cancer (people who ate the most red meat were almost 40% more likely to develop colon cancer), and diabetes (for every increase in the number of daily servings of red meat there was a 26% increase in the risk of developing diabetes)

So I decided to try to find some studies that demonstrated benefits to the consumption of red meat. I searched Medline for roughly an hour and the only articles I could find had to do with helping young women get enough iron by consuming more red meat.

Is red meat the only source of iron? Nope. Folks can get iron by consuming iron rich foods (iron-fortified cereals, tofu and soy products, poultry, almonds, dates and prunes) along with Vitamin C to help absorption, cooking with iron skillets/cookware, and avoiding the combination of iron rich foods with those that block iron absorption like tea and coffee, high fibre meals and calcium supplements.

Or of course you could also simply go out and buy an iron supplement and take that.

Sometimes proponents of red meat will talk about zinc and vitamin B12. Indeed red meat's a fantastic source of both, but why would I want a source of zinc (also found in poultry, beans, nuts, whole grains and fortified cereals), and B12 (also found in poultry, eggs, mollusks, fish, and fortified cereals) that upped my risk of developing various cancers when I could get both from other sources or once again, go out and buy a supplement?

Going back to the Heart and Stroke Foundation, the only answers I have as to their recommendation we eat red meat are cynical ones. The nicest one I can come up with is that they figure folks are going to eat red meat anyhow so they might as well recommend that we eat the leanest cuts therein and in so doing avoid the processed meats that have been shown to worsen the risks of red meat consumption. The meanest ones have to do with them having their heads in the sand, bureaucratic quagmire, or tunnel-vision incompetence.

Health Canada of course wants folks to eat red meat. According to their atrocious Food Guide, they want post-menopausal women to consume up to 150 grams of it a day, thereby increasing their risk of breast cancer by more than 60%, their risk of colon cancer by 40% and their risk of developing diabetes by over 50%.

MMMmmmm super healthy. Way to go Health Canada!

For Health Canada I don't have a nice answer as to why they recommend we consume red meat. For them it's absolutely due to the combination of tunnel-vision incompetence with both political and industry pandering.

"Canadian Guidelines make little distinction between consumption of red meat, beans, fish, and poultry. Although they advocate lean meat, this is only a small fraction of the red meat in the food supply and the guidelines are silent about usual cuts of meat and processed meats, which are a huge part of the North American diet. Thus, the Guidelines seem unbalanced; the evidence would suggest that red meat and particularly processed meats should be limited, and that a combination of fish, poultry, nuts, beans and soy, and occasionally lean meat be the primary protein sources."

(In case you don't remember, Dr. Willett has been the chair of nutrition at Harvard since 1991, is without a doubt the world's leading nutritional epidemiologist and is the second most cited scientist in the history of clinical medicine.)

The only reason I can think of to eat red meat is taste. I adore the taste of red meat, but not for one second do I try to kid myself that red meat is a healthy choice, I simply eat the smallest amount of it that I feel I need in my life in order to be happy.

Plainly and simply red meat is not a healthy choice. It should not have a "Health Check" from the Heart and Stroke Foundation and of course they should and do know better.

This will begin an ongoing series on unhealthy "Health Checks" from the Heart and Stroke Foundation - I will be keeping my eyes peeled for them in the Supermarket. Should anyone out them come across one that they wonder about, please send it my way.

Thursday, April 19, 2007

For those of you new to my blog (this past week has seen a lot of new subscribers to the blog's email feed), you may not know that on Fridays I post something usually unrelated to anything other than being in some way shape or form humorous.

You may also not know that if you're a feed subscriber, you'll have to log on to the blog itself in order to watch the videos.

Today for Funny Friday, a grouping of 3 great Ikea commercials (they get better as they go).

I have to just quote from the press release, because it's just too weird for me to paraphrase,

"The research revealed that, ideally, the ‘crunching’ sound made when you tuck in to those crispy rashers should measure 0.5 decibels when eaten, and they should break when 0.4 Newtons of force is applied through chewing.

The butties were tested using a high-tech computer that measures food texture, while taste panels consisting of 50 eager volunteers judged the butties for taste, texture and flavour. Further consumer group research by Danish Bacon confirmed that the formula is a clear favourite with bacon fans – over 60 per cent gave the bacon butties prepared using the new equation the ‘thumbs up’."

But the best part of this incredible waste of 1,000 hours of time comes from the same press release's "recipe" to make your perfect bacon buttie at home. Their "step-by-step guide to the perfect bacon buttie" has a grand total of six steps:

Cut two slices of white farmhouse bread (one to two centimetres thick)

Take two or three (or more!) rashers of Danish back bacon (smoked or unsmoked – whichever is your preference)

Place under preheated oven grill for approximately seven minutes on high (preferably 240 degrees)

Turn once during cooking

Add sauce to taste

Eat and enjoy!

Or to summarize, get white bread, buy our brand of bacon, cook it and eat it.

You've got to hand it to Big Bacon though, this thing hit the New York Times.

Tuesday, April 17, 2007

There's a press release in my inbox this morning. It's from the Canadian Food and Beverage Industry (Big Food) and basically it details how our clearly misguided government has decided to not only continue to allow food advertisers to target our children, but is now holding their hand while they do so.

"Joined by the Minister of Health, the Hon. Tony Clement, Concerned Children's Advertisers (CCA), Food & Consumer Products of Canada (FCPC) and Advertising Standards Canada (ASC) laid out the unique, integrated approach Canada is taking to help children and their families make wise choices related to healthy eating and active living."

I know, I know, you think that sounds good - well let me continue.

Here are the 3 initiatives:

1. Long Live Kids: A series of public service announcements addressing healthy eating and physical activity (with a specific emphasis on the Food Guide that tells us white bread, red meat and chocolate milk are healthy choices).

2. A voluntary initiative of 15 Canadian food and beverage companies to specifically target under 12 year olds with the promotion of healthy dietary choices and/or active living messages in at least 50% of their advertising.

3. New interpretation guidelines for children's food and beverage advertising have been added to the Broadcast Code for Advertising to Children and the Canadian Code of Advertising Standards.

So let's go through these one by one.

Long Live Kids - I won't bash this one other than the fact that again it's going to promote a Food Guide that as I've detailed at length before, does not represent what science understands to be the healthiest known diet and specifically allows advertisers like Big Milk to recommend to Canadian parents that they give their children 2 glasses of chocolate milk a day.

Voluntary ads - Do you think that maybe, just maybe, the companies involved are going to spend their time promoting themselves as healthy, concerned, part of the solution type corporations? Do you think that they're going to try to leverage these messages to try to imply that their entire brands are healthy? That's sure as heck what I would do if I were one of these corporations. Want to know which corporations we're talking about? Cadbury Schweppes, Campbell, Coca-Cola Ltd., General Mills, Hershey, Janes Family Foods, Kellogg, Kraft, McCain Foods, McDonald's, Nestlé, Parmalat, PepsiCo, Unilever and Weston Foods. Paragons of health all.

Last month the Kaiser Family Foundation released their report, "Food for Thought" detailing advertising targeting children in the United States. They reported that on an annual basis children between the ages of 2-7 (an age too young to discern truth from advertising) see an average of 13,904 TV ads per year, a number that goes up to 30,155 ads per year for kids between 8-12. Of those ads, over half of them on children's programming were for food.

Assuming of course that Canadian airwaves are comparable, even if 50% of the ads are taken away, our 2-7 year old children will still see on average 6 ads every day for crappy food while our 8-12 year olds will see 11.

Of the food ads 34% are for candy and snacks, 28% are for cereal, and 10% are for fast food while 4% are for dairy products, 1% are for fruit juices, and none are for fruits or vegetables.

So basically, Big Food corporations like McDonald's and Cadbury will now not only be able to continue pummelling our children with calls to eat unhealthy foods, now they'll also be able to build brand recognition as healthy, responsible corporations partnering with our government in the battle against childhood obesity and chronic illness.

Tightening of regulations - Want to know what's changed? There will be a Committee, one that INCLUDES industry, that will be preclearing commercials with the specific aim of ensuring that the portions represented in the commercial will be of adequate size.

Woo Hoo?

Bottom line - the Government's failed us again. Whether through willful catering and pandering to the industry powerhouse of Big Food or simply through ignorance, they've taken an opportunity to do something good (like simply ban food advertising targeting children who can't discern truth from advertising) and instead created a situation where Big Food can claim in their ads that they're now part of the solution.

All kidding aside, what the headline did do was spur me to read the actual article published in the Wisconsin Medical Journal entitled:

"Calories from Newspaper Dessert Recipes are Associated with Community Obesity Rates"

After reading the methodology and the paper, I can say that without a doubt this is the weakest article I have ever read that was actually published in a peer-reviewed medical journal.

Here are their methods:

"3 cities with populations of 400,000 or more were selected from 4 geographic areas within the United States....All recipes published in major newspapers for those cities in the last week of August 2000 were accessed....and the nutrient content for each recipe was calculated....data were entered into an Excel spreadsheet and analyzed with SPSS using linear regression and correlation."

So basically a bunch of large cities had their obesity rates plotted against one week's worth of local newspaper recipes' Caloric contents.

The authors concluded,

"In this study, we found that caloric intake of recipes published in major newspapers are correlated with community obesity rates."

The authors do admit that there are limitations to the study,

"Limitations of this study stem primarily from the correlational study design that may lead to the "ecological fallacy" where the observed correlation may be due to some underlying differences between the communities included in the study, such as demographics or health care"

Um, yah think?

Two things blow me away about this study. Firstly that any self-respecting scientist would publish correlational data based on a SINGLEweek's worth of data boiling down an incredibly complex social and medial condition with dozens, if not hundreds of possible hypothetical contributors, to have cause from a single observational variable, and secondly that somehow this thing passed peer review.

[note to self, if I ever have a poorly designed study that I can't get published elsewhere maybe consider the Wisconsin Medical Journal]

This study reminds me of a story published a few months ago in the Economist where Toronto based scientist Peter Austin "proved" that those burn under the astrological sign of Sagittarius were 38% more likely to be admitted to a hospital with a broken arm. The difference between Austin's ridiculous conclusion and these authors' being that Dr. Austin purposely designed his study to promote a ridiculous result so as to call to question conclusions like the one above and highlight the need for proper study methodologies and statistical analyses.

Friday, April 13, 2007

Let's say you have an irrational, severe and fairly bizarre phobia. Let's also say that you get picked on and made fun of because of it with kids in school calling you names. Do you think it would be a good idea for you to appear on a national television tabloid show to face and discuss it?

For Funny Friday, here is a truly bizarre clip from the Maury Povitch show. I only hope that she got paid for her appearance and that Maury's show was successful in freeing her of her phobia because if it wasn't, I don't think this clip will have helped her cause much.

Wednesday, April 11, 2007

Launched back in 2005 at the tail end of the low-carb craze and noticed by me last night, is the Coca Cola company's Powerade Option sports drink.

It's sweetened with both Splenda and high fructose corn syrup and thereby keeps its Calories at a very low 10.

It's a bit of a dilemma for me as to whether or not I think it's a good idea. On the one hand, it's low Calorie which I like, but on the other hand, if you've actually exercised long enough to need some additional fuel (meaning you've exercised vigorously for 45 minutes or more) the lack of carbs in this product will belie that aim.

Generally my advice is always to eat your Calories, but some folks, myself included, find it tough to eat during vigorous activity. When I go for 2 hour bike rides my fuel of choice is often a sports drink diluted to 1/2-3/4 of its intended strength.

So moderate ramble made short. I'm glad there's a sports drink option that's low Calorie, but in general, most folks don't need sports drinks and for those who do, this one's probably not the right choice.

Tuesday, April 10, 2007

I cut this absolutely obscene ad out of this month's Chatelaine magazine (click it to get a larger image).

It depicts a toddler with a jackhammer and implies that for the sake of his health his parents should give him the two daily glasses of chocolate milk that the Canada's Food Guide directly espouses.

"As a parent you want to do all that you can to prepare them for the future. And that includes giving them plenty of milk. Canada's Food Guide to Healthy Eating recommends kids get at least two servings of milk, chocolate milk, or milk products every single day"

As many of you know I testified before the House of Commons Standing Committee on health regarding the Food Guide and childhood obesity and you probably also know that the Committee two weeks ago released their damning report on the state of childhood obesity in Canada.

Canada has the 5th heaviest children in the developed world, with 26% of young adults aged 2-17 overweight or obese and hence the dire implication therein that this generation of children won't outlive their parents.

Unfortunately the Committee was silent on the issue of Canada's Food Guide.

Not so silent were the Heart and Stroke Foundation, the Canadian Diabetes Association and the Dietitians of Canada, all of whom gloriously praised the virtues of this guide.

Perhaps they're hoping that it will help build their respective businesses?

Who cares if long term epidemiological studies fail to tie in high levels of milk consumption with lower levels of osteoporotic fractures? Who cares if higher levels of dairy consumption have been shown to be associated with increased incidences of ovarian cancer and fatal and aggressive prostate cancers?

For goodness sakes people, it came from a cow so it has to be healthy! Didn't you know, God put cows on earth as magical, majestic, nutritional miracles? Why they provide us with milk and red meat the two healthiest substances known to man....at least according to the folks who farm them.

Once again, I can't blame the milk industry, they're just trying to hawk their wares, but I sure hope Health Canada gets a big commission - it'll need one to help pay for the rapid increase in diseases like diabetes if in fact Canadian parents pay heed to the very unwise recommendation to feed their children two glasses of chocolate milk daily and help their children gain as much as 36lbs per year from the liquid Calories therein.

Once again, shame on you Health Canada, you're failing our nation and our children, and shame on any registered dietitian or health professional affiliated with the milk industry who isn't speaking out about this outrageous advertising campaign.

Monday, April 09, 2007

A few weeks ago I posted about that amazing new Japanese pizza invention - the one that added insane amounts of Calories to your meal by stuffing the crust not only with cheese, but with bacon and sausage as well.

Friday, April 06, 2007

I've often referred to myself as "anti-dextrous" - bad at both hands, and spent much of my childhood getting picked last or second last for various sports.

My eldest daughter, bless her sweet little heart, seems to have inherited my natural sporting abilities as demonstrated by the fact that she didn't learn to roll over until she was over the age of one and watching her play, let's just say she's not exactly a whirling dervish.

To make me feel worse about it all I came across this video. It's a toddler more co-ordinated than me and it's this week's pick for Funny Friday.

Tuesday, April 03, 2007

So I'm in Toronto this weekend and the batteries die in my Nike +ipod Sport kit and I forgot my pedometer and I want to know how far my run was.

I could jump in my car and drive out the route, or I could use Google Pedometer.

Called Gmap Pedometer it's a mashup of Google maps that allows you to measure any route you'd like.

Simply zoom into whereever you'd like to map, double click on your starting point and all points in between and Gmap Pedometer will work out your distance.

Yesterday it told me I'm slow.

It's not the most beautiful interface, but for its ease of use and its high degree of functionality I give gmap pedometer an A.

Oh and by the way, there's no right number of steps you should take in a day. All this ridiculousness about 10,000 - fact is the best goal step wise is to take as many as you can enjoy, because if you try to take more steps than you enjoy, you'll stop taking them altogether.

Monday, April 02, 2007

Tonight my daughter's going to ask the first of the traditional four questions of the passover seder.

I thought, in honour of the event, that I provide you with four simple questions - four questions where if you answer yes to all of them, there's a great chance that hunger's not influencing your choices, and if you answer no to one or more, a great chance that you often eat portions or choices inconsistent with your weight management goals.

So here they are:

Do you have at least 300-350 Calories for breakfast within 1 hour of waking?

Do you always have a meal or a snack within 3 hours of your last one?

Do you have at least 3 meals and 2-3 snacks daily?

Do you have protein with every meal and snack?

If you're struggling right now with "sticking to a diet", remember that dieting doesn't work and that the primary reason is that suffering doesn't work. Try to get 4 yeses and see if that doesn't help.

Remember, reasonable jumps out the window when hunger enters the room.

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About Me

Family doc, Assistant Prof. at the University of Ottawa, Author of The Diet Fix, and founder of Ottawa's non-surgical Bariatric Medical Institute - a multi-disciplinary, ethical, evidence-based nutrition and weight management centre. Nowadays I'm more likely to stop drugs than start them. You can also follow me on Twitter and Facebook.

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